Tune in to This Network

By Fred Lerner, DC, PhD, FACO

The fastest and best way I know of to build a practice in any community is by establishing a network of referring practitioners. Having been in private practice for 20 years, it is my experience that nothing works better.

Having taught acupuncturists for 10 years, I have found that, as a profession, acupuncturists tend to be very isolated in the health delivery system. To any acupuncturist reading this article, I ask you to start thinking about "coming into the light" if you haven't done so already. Start working with other providers in the system. It works.

Whether you are just starting out, or if you have been in practice for 20 years, there is nothing like being able to focus on your objectives to attain them. The greater the clarity of your focus, the easier and quicker you will reach your goals. If you ever get a chance to take a class with Marilyn Allen, you will usually hear her say at some point: "where your focus goes, your energy flows, and that's what grows."

To build a referral practice, first envision what kinds of patients you would like to see. If you want a chronic pain practice, you should have a list of referral doctors that includes an anesthhesiologist who treats chronic pain; an orthopedic surgeon with the same type of patient population; a neurologist; a physiatrist (physical medicine and rehabilitation); a pain psychologist; a rheumatologist; and so on. If you want a sports-related practice, think of all the medical and chiropractic professionals involved in sports medicine. With internal medicine, specialties like gastroenterology and internal medicine come to mind. Think about worker's compensation, and orthopedic surgeons (spine surgeons, hand surgeons, etc.), physiatrists, occupational medicine specialists, etc. should "click" in your head.

Building referral sources generates many simultaneous benefits. First, you will learn about various Western tests, when to order them and what they mean. Your clinical diagnostic skills will excel. Second, you will share the liability load with different doctors, so that if there is a life-threatening illness, the odds are much greater that it will be picked up. Third, when you refer a patient to someone, they usually send another one back to you. Generally, there is no greater quality of patient than one who was referred by another practitioner.

Where do you find these doctors? One way is to think of an MD you know and have a good relationship with. If you know one, ask him or her about their referral lists (they all have them). Ask if they would mind if you could use them as a reference. If they like you, they may even call the specialist on your behalf and pave the way for you. After all, that's how they built their own practice, and they know how the game works. Once you establish a good relationship with the specialist, you can ask the specialist who they use and repeat the process until you have your network in place.

What will it take for these specialists to refer to you? The number one reason is affinity. If they like you and you like them, everything flows from there. They will go through their needs from you and your office. They will also want to know when to send patients to you. Think about your answer before they ask you, "What kind of patients do I send to you?" Do you know right now? Well, you'd better know by then, so prepare now.

Let's get back to the "focus" concept. How do you get a referring doctor to focus on sending you an acupuncture patient? One reason is that they are being asked several times a day by patients, "What do you think about acupuncture?" Acupuncture is a very hot topic right now.

How will they think of you in particular? Most of us bring our office cards when we go to meet a potential referral source. That's nice, but it won't usually work well. Think about it. What do you do with the cards you get? Don't you stick them somewhere in a drawer, where you never see them? Out of sight, out of mind.

What you want is visibility. I took a page from physical therapists years ago. They developed prescription pads that detail what they do. The pads contain their address; phone and fax number; how many times a week the doctor wants them seen; how many weeks a month; and most important, a map to their offices. Those pads do not go into a drawer. They remain on a working counter or a desk where the doctor sees them several times a day.

Develop your own acupuncture prescription pad. If you have a computer, you can do it with a common word processing program. Take your "camera ready" paper to a printer and get gummed pads (50 per pad). When you meet your doctors, give them a couple pads. If you want a sample, you can contact me for one via e-mail. A prescription from a doctor is extremely helpful when you are trying to get authorization from a case manager or adjuster.

One of the specialist's main concerns is liability. The longer you are in practice, the more you will become aware of liability and your own risk of treating patients. If a doctor refers a patient to you and you inadvertently hurt them, the referring doctor may inncur some risk for making that referral. Referring practitioners need to know that you understand the Western system. You will need to know how to take a proper history, examine, diagnose (Western) and treat. You will need to know how to document your daily visits, presumably using the SOAP system. Overall, you will need to converse with doctors on their terms, not yours. Finally, and probably most difficult, you will have to learn what your own limitations are in terms of treating and managing patients.

When you are done with the course of treatment, send the patient back. It is very bad form not to, unless you are specifically advised not to by the referring doctor. It is also a bad idea to get a patient from one specialist and refer to another specialist without first conferring with the referring one. You should really view that patient as the referring doctor's rather than your own. If the situation was reversed and you referred a patient to someone, how would you feel if that specialist sent your patient to someone else without consulting you?

Once you get used to working with a referral system, you will become better able to recognize when to refer to the doctors who refer to you. When you first see a patient, several questions will come up: How far should you go in your attempts to get them well? Do you know what entity you are dealing with? Is it merely a collection of symptoms, or is there something far more sinister (e.g., cancer) lurking beneath the surface? How important is it to know? How sure are you? Should you refer for a special test? A consult exam with a different specialist? A different treatment? Do you know when to hold 'em and when to fold 'em? How good of a patient manager are you?

If, along the course of exam and treatment, you decide to refer the patient, it is much nicer and safer to have an existing working relationship with the appropriate specialist. You will provide a much better service to your patient, and enhance your own reputation in the community.

If you want to survive and prosper as an acupuncturist, being a good manager of patients is a consummate skill and is probably the most potent item in your arsenal. If you didn't get that lesson in "practice 101" in acupuncture college, you'll get it working with referral doctors.

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